doreentao 发表于 2018-12-26 12:04:40

J Hypertens:脑卒中后急性期SBP和降压治疗对跌倒风险的影响

本帖最后由 doreentao 于 2018-12-26 12:06 编辑

急性卒中后的血压变化尚未得到充分研究。近日,高血压领域权威杂志Journal of Hypertension上发表了一篇研究文章,该研究的目的是描述卒中患者急性期SBP的发展趋势,并研究在此阶段强化降压治疗是否与跌倒风险的短期预后相关。

该观察性研究是哥德堡秋季研究的子研究,纳入了421例连续入住卒中单元的患者。研究人员分析了受试者血压测量数据、抗高血压治疗和跌倒的医疗记录。重复测量数据的随机系数模型用于分析SBP的变化,并采用单变量Cox比例风险模型来估计预测因子对前10天内首次跌倒的影响。

在卒中发病后的前两天,所有卒中患者的平均SBP下降了14.9mmHg(95%CI为12.3至17.4,P<0.0001),并且在发病后2-7天进一步下降2.3mmHg(95%CI为-0.1至4.7,P=0.066)。无论是否进行抗高血压治疗,SBP的降低都具有统计学意义。急性卒中后第一周内强化降压治疗与跌倒风险之间没有关联。

由此可见,该研究的结果表明急性卒中前两天内SBP自发降低。无论卒中类型、年龄和是否进行抗高血压治疗,SBP都会有所降低,并且卒中前7天内强化降压治疗与跌倒无关。

参考文献:
Kjellberg, Sigvar, et al. SBP and antihypertensive treatment in the acute phase after stroke and its impact on the risk of falling. Journal of Hypertension, 2018.


AbstractINTRODUCTION:Blood pressure development after acute stroke is inadequately studied. The objectives of this study were to describe SBP development among patients in the acute phase after stroke, and to investigate whether intensified antihypertensive treatmentduring this phase was associated with short-term prognosis regarding the risk of falling.PATIENTS AND METHODS:This observational study is a sub-study of the Fall Study of Gothenburg and included 421 consecutive patients admitted to a stroke unit. Medical records were studied for blood pressure measurements, antihypertensive treatment and falls. Random coefficient models for repeated measures data was used to study change in SBP. Univariable Cox proportional hazards model was used for estimation of predictors' effect on time to first fall within first 10 days.RESULTS:During the first two days after stroke onset, mean SBP for all stroke patients decreased by 14.9 mmHg (95% CI 12.3-17.4, P < 0.0001) and further 2.3 mmHg days 2-7 after onset (95% CI -0.1 to 4.7, P = 0.066). The decrease in SBP was statistically significant irrespective of the use of antihypertensive treatment. No association was found between intensified antihypertensive treatment in the first week after acute stroke and the risk of a fall.CONCLUSION:The findings show a spontaneous decrease of SBP during the first two days after acute stroke. This reduction in SBPseems to be present regardless of stroke type, age and use of antihypertensive treatment. No association between intensified antihypertensive treatment during the first 7 days after stroke and falls was found.

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